Secondary prevention
Prompt recognition and treatment of infection is vital to prevent worsening of MG symptoms. Infections are major provoking factors for myasthenic crisis. Corticosteroids and other immunosuppressive drugs may mask the usual clinical signs and symptoms of infections.
Appropriate management before, during, and after elective surgery minimizes risk of myasthenic crisis.[162] The patient should have a thorough evaluation by a neurologist prior to scheduling the surgery with regard to optimization of medical management of MG and screening for potential risk factors for crisis. The neurologist must check breathing and swallowing functions. Potential risk factors for crisis should be monitored and actions must be taken to avoid infections, volume depletion, aspiration, and drugs such as high-dose corticosteroids and certain antibiotics (aminoglycosides, ciprofloxacin, clindamycin, erythromycin) or curare-like derivatives.
Considerations for anesthesia include reversing nondepolarizing neuromuscular blockade agents, obtaining sufficient spontaneous breathing with no residual curarization before extubation, limited use of opioids and sedatives, avoiding routine admission to the intensive care unit, and possible use of peripheral nerve blocks for adjunct pain control.[162][163]
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